Does intensive therapy of type 2 diabetes help or harm? Seeking accord on ACCORD.
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial tested the hypothesis that intensive glucose-lowering (with a hemoglobin A1c target of less than 6.0%) would reduce the incidence of atherosclerotic disease events and death compared with standard treatment (with a hemoglobin A1c target of 7.0% to 7.9%) in more than 10,000 patients with type 2 diabetes at high risk of cardiovascular events. The study was terminated early because more people had died in the intensive-treatment group than in the standard-treatment group (257 vs. 203). The ACCORD results should not substantially alter our usual approach to glucose-lowering, which should still be "as low as we can get it safely" while avoiding hypoglycemia, significant weight gain, complex regimens, and, perhaps, the "stress" of maintaining glycemic control, especially in patients at high risk of coronary heart disease.
Hoogwerf
Byron J
BJ
Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, OH 44195, USA. hoogweb@ccf.org
D001786:Blood Glucose / Q000187:drug effects; D003324:Coronary Artery Disease / Q000401:mortality / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents